Osteomyelitis

Dr. Mohammad ali Hajighasem MD

Orthopedic surgeon

Firoozgar Hospital

osteomyelitis

Osteomyelitis is an inflammation of bone caused by an infecting organism

it may remain localized, or spread through the bone to

involve the marrow, cortex, periosteum, and soft tissue

CLASSIFICATion

acute, subacute, chronic;

exogenous hematogenous.

ACUTE HEMATOGENOUS OSTEOMYELITIS

it is caused by bacteremia localized trauma debilitation from a chronic illness, malnutrition, inadequacy of the immune system,.

younger than 2 years between 8 and 12 years

age

• In children yanger than 2years vessels cross the physis and may allow the spread of infection into the epiphysis

Otherwise, the physis acts as a barrier

The metaphysis has relatively fewer phagocytic cells, allowing infection to occur more easily in this area.

abscess breaks through the thin metaphyseal cortex and forms a subperiosteal abscess.

acute osteomyelitis in an infant may cause shortening or angular deformityas a result of damage to the physis or epiphysis.

In children older than 2 years of age, the physis still prevents the spread of a metaphyseal abscess into the epiphysis.

in children older than 2years of age, the

metaphyseal cortex is thickerthe spread of

infection into the diaphysis, the endosteal blood supply to the bone will be jeopardized. The periosteum also is lifted

off the bone by the abscess, endangering the periosteal blood supply

Results inextensive

sequestrum

chronic osteomielitis

Hematogenous osteomyelitis

in this age usually affects the vertebral bodies.

epiphysis, metaphysis, or diaphysis; abscesses spread slowly, and large sequestra

rarely form.

After the physes have

closed, exogenous

osteomyelitis becomes more

common

Some physis is within capsule, metaphyal osteomyelitis may cause septic arthritis

proximal femur proximal humerus, radial neck distal fibula

Older children Staphylococcus aureus adults Gram-negativeexogenous. Mixed floral (gram positive and gramnegative negative heroin add Pseudomonas chronically ill patients fungal sikel cell hemoglobinopathies Salmonella

infants, S. aure , B Streptococcus and gram-negative colifor also arecommon.

DIAGNOSIS history pain weekness high or low tempratur anorexi

Paraclenic CBC ESR X RAY MRI blood cultur bone scan bone aspiration

Magnetic resonance imaging shows changes in the marrow and soft tissues from an inflammatory response.

Blood cultures yield the infecting organism in about 50% of patients.

Bone aspiration should be performed to aid in establishing an accurate bacteriological diagnosis and to determine if an abscess is present.

TREATMENT

Surgery and antibiotic

areas of simple inflammation without abscess formation will respond to antibiotics alone

1) an appropriate antibiotic will be effective before pus formation; (2) antibiotics will not sterilize avascular tissues and purulent material that must be removed surgically; (3) if such removal is effective, then antibiotics should prevent their reformation and therefore primary wound closur should be safe; (4) surgery should not further damage already ischemic bone and soft tissue (5) antibiotics should be continued after surgery.

Acute septic arthritis results from bacterial invasion of a joint space

Acute septic arthritis

Dr. Mohammad ali Hajighasem MD

Orthopedic surgeon

Firoozgar Hospital

hematogenous spread, direct inoculation from trauma or surgery, contiguous spread from an adjacent site of osteomyelitis or cellulitis.

Age

, young children

elderly individuals

Predisposing factor immature immune system, immune compromise for any reasonneoplasms, alcoholism, diabetes mellitus, rheumatoid arthritis, systemic lupuserythematosmalnutrition, chronic hepatic or renal failure, intravenous drug use, previous joint trauma or arthritis

serious complications in children destruction of the epiphysis avascular necrosisfrom increased intracapsular pressure and septic effusion.

neonates, Streptococcus neonates who are hospitalized, Staphylococcus, Candida, and gram-negative children under 2 years of age Haemophilus influenzae type B systemic lupus erythematosus, Salmonellaintravenous drug user gram-negative pseudomonas.

Diagnose, inflammatory responses are blunted signs fever, swelling, erythema, and pain may be minimal or lacking. The only finding in a neonate may be infection atanother site (e.g., the umbilical catheter), irritability, failure to thrive, asymmetry oflimb position, or displeasure at being handled.

.

Erythrocyte sedimentation rates C-reactive proteinsynovial leukocyte counts above 50,000/mm3 28,000/mm3polymorphonuclear cells, if more than90

joint aspiration

preparations of Haemophilus endotoxin and a staphylococcal culture medium stimulate release ofmetalloproteases, including collagenase. The release of these enzymesappears to be mediated by the cytokine interleukin-1 (IL-1), which probably isproduced locally by monocytes but may be secreted by chondrocytes.

Treatment of acute septic arthritis: (1) the joint must be adequately drained, (2) antibiotics (3) the joint must be rested in a stable positione

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